Jakab Ferenc
Fővárosi Önkormányzat Uzsoki Utcai Oktató Kórház Sebészeti-Érsebészeti Osztály Budapest Uzsoki u. 29. 1145.
Orv Hetil. 2010 Nov 21;151(47):1956-60. doi: 10.1556/OH.2010.28988.
Surgical strategy of colorectal liver metastases depends on clinical and pathological response to neoadjuvant chemo- and target therapy. Recently, surgical treatment of advanced colorectal cancer appears as an everyday challenge for surgeons and oncologists. The new oncologic procedures invented last years led to significant therapeutic improvement. Combination of neoadjuvant chemotherapy with biological answer modifiers increased greatly the clinical response rate given to cytoreductive therapy. Due to these facts the complete disappearance of liver metastases can be observed more and more frequently after 2000. Literature of metastasis surgery clarified the exact difference between clinical and pathological response, at the same time exact criteria of the connections between two responses have been set. In complex treatment of colorectal liver metastases complete pathological response became the end point of treatment.
Between January, 2009 and August, 2010, 39 patients with originally non resectable liver metastases (colorectal cancer origin) have been studied. All patients were treated by neoadjuvant chemo- and targeted therapy before the resection of liver.
Complete pathological response has been observed in 3 patients, major pathological response (necrosis: >50%) in 11 patients, minor pathological answer (necrosis <50%) in 22 patients and finally no necrosis at all in 3 patients.
Complete pathological response can be regarded as the final goal of neoadjuvant targeted therapy. Pathological response seems to be the most important prognostic factor which reflects long-term survival after the R0 resection of liver metastases. Complete disappearance of liver metastases is an undesirable side effect of oncological therapy, which causes difficulties during surgical intervention. In this term the overtreatment of patients resulting in a disappearance of metastases should be avoided. Multidisciplinary team is responsible for the indication of resection of liver metastases in time before their disappearance.
结直肠癌肝转移的手术策略取决于对新辅助化疗和靶向治疗的临床及病理反应。近年来，晚期结直肠癌的外科治疗对外科医生和肿瘤学家而言是一项日常挑战。过去几年发明的新肿瘤治疗方法带来了显著的治疗进展。新辅助化疗与生物应答调节剂的联合使用极大地提高了细胞减灭治疗的临床反应率。鉴于这些事实，2000年以后肝转移灶完全消失的情况越来越常见。转移瘤手术的文献明确了临床反应与病理反应的确切差异，同时也确定了两种反应之间联系的精确标准。在结直肠癌肝转移的综合治疗中，完全病理反应成为了治疗的终点。
2009年1月至2010年8月期间，对39例最初不可切除的肝转移瘤（源自结直肠癌）患者进行了研究。所有患者在肝切除术前均接受了新辅助化疗和靶向治疗。
3例患者出现完全病理反应，11例患者出现主要病理反应（坏死：>50%），22例患者出现轻微病理反应（坏死<50%），最后3例患者完全没有坏死。
完全病理反应可被视为新辅助靶向治疗的最终目标。病理反应似乎是最重要的预后因素，它反映了肝转移瘤R0切除术后的长期生存情况。肝转移灶的完全消失是肿瘤治疗的不良副作用，会给手术干预带来困难。就此而言，应避免因转移灶消失而导致患者过度治疗。多学科团队负责在肝转移灶消失前及时确定肝转移瘤切除术的指征。
